Stevens seeks consensus but his plans will challenge all

It would be an exaggeration to say Simon Stevens’ arrival as chief executive of NHS England has the same resonance within the service that President Obama’s 2008 election had with large swathes of the US population – but not by much. Another, perhaps more pertinent, comparison is with the Blair landslide of 1997.

“Things can only get better” sang D-Ream and it was the contrast between the confident modernism of New Labour with the knackered Conservative administration which generated the electoral tsunami. Senator Obama too promised “hope” and “change”.

Mr Stevens’ promise to “Think like a patient, act like a tax payer” shows he understands the importance of strong, clear, simple messages which act as rallying calls to many.

A broad swathe of the electorate were able to project their hopes onto Mr Blair and senator Obama – and so it is with Mr Stevens. Those lining up in HSJ to offer him their advice represent a wide spread of health service opinion all with high expectations the NHS England chief can deliver.

His first speech scatters crumbs to those who would see new (private sector) providers take a greater role in the NHS as well as those who champion the system’s cohesiveness. But Mr Stevens’ political nous will constantly remind him of two things; he cannot please all those people and that his honeymoon period is finite.

That means he will be keen to determine a relatively limited set of priorities over his first three months; work to win a broad consensus for them by autumn; and then attempt to create some momentum behind his plans before the election traps everything in molasses.

Mr Stevens will not want to indulge in pointless arm-wrestling with government or other agencies in an independence virility test. His speech takes pains to highlight the new consensus on health policy on which – broadly - all three main political parties are campaigning.

Behind the scenes some of his messages will be tougher. He is unlikely to join his predecessor, Sir David Nicholson, in thumping the tub for more NHS resources. But as the economy recovers, he will be presenting a carefully prepared analysis of what needs to be done and the price any government may pay for not providing the necessary funding. Would any government want to be responsible for the fourth consecutive fall in the proportion of GDP represented by NHS spending – as currently is due to happen in 2015-16 – he is likely to ask?

Mr Stevens will also be eager to lift the NHS’s eyes to the horizon – and to encourage the service to explore how it can make the most of the significant advances in genetic medicine and other innovations, which could have a seismic impact on the lives of the English public but have been largely absent from the debate on the NHS’s future.

The thing most likely to get him drumming his fingers on the desk is the suggestion that anything other than the most carefully thought out structural reorganisation is the answer to any persistent problem.

He wants to quickly silence the incessant chatter about the number and role of clinical commissioning groups and to challenge the idea hospitals have to be big to survive. He will instead be keen to explore models of delivery which cut across boundaries within and without healthcare.

But Mr Stevens’ welcome and nuanced approach will prove challenging to the NHS and its masters. Some of the models he will encourage are likely to prove much more disruptive than the mild experimentation we have seen to date; meanwhile the new NHS England chief executive will sternly resist politicians’ attempts to place the service into any kind of media and voter friendly policy straightjacket.

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